Global strategies for Women, Children and Adolescents Health in SDG times Prof dr Marleen Temmerman VVN, Brussels 25/09/2017 Short bio • MD, MPH, PhD, OB/GYN • Academic: Ghent University, University of Nairobi • Politics: elected Senator Belgian Parliament • WHO Director Reproductive Health and Research • Aga Khan University, East Africa VUB 1981-87 Prof Jean-Jacques AMY University of Nairobi 1987-92 Prof Peter Piot Research agenda • Can women get infected with the HIV virus? • If so, can it have an impact on pregnancy and newborns? Founding Director International Centre Reproductive Health 1994 Quality of Care for pregnant women and newborns- the WHO vision. BJOG 2015 Filename Reproductive Health and Research thematic areas • Promoting family planning/contraception • Adolescent sexual and reproductive health • Improving maternal and perinatal health • Prevention of unsafe abortion • Sexually transmitted and reproductive tract infections • Linkages between sexual and reproductive health and HIV/AIDS • Sexual health, gender and reproductive health • Research capacity strengthening and programme development • Advocacy and communications for SRH and for HRP/RHR "We will spare no effort to free our fellow men, women, and children from the abject and dehumanizing conditions of extreme poverty, to which more than a billion of them are currently subjected." United Nations Millennium Declaration September 2000 Millenium Development Goals Global Strategy for women's and children's health (2011- 2015) Every woman every child The MDGs and the Global Strategy 2010 The UNSG’s 2015 progress report: • Health of women and children is now higher on the political agenda • Over 300 stakeholders from all constituencies made 400 commitments • US$45 billion in new financing, almost 60% (US$ 34.2 billion) disbursed • New global initiatives were launched • 1000 innovations have been selected and supported • Landmark accountability framework for women and children’s health MDG 5: Improving maternal health Maternal mortality has nearly halved since 1990 1000 900 870 800 700 600 500 400 430 400 300 210 Maternal mortality rate mortality Maternal 200 100 26 16 0 1990 1995 2000 2005 2010 More developed countries Global Least developed countries Filename MDG 4 – Reduce child mortality Since 1990 the global under-five mortality rate has dropped 49 percent Under-five mortality rate decline, 1990 and 2013 Overall reduction in U5MR from 90 deaths per 1,000 live births in 1990 to 46 per 1,000 live births in 2013 Source: UN Inter-agency Group for Child Mortality Estimation. 2014. Major causes of mortality Causes of maternal mortality Causes of newborn and child mortality "Women are not dying of diseases we can't treat. ... They are dying because societies have yet to make the decision that their lives are worth saving.“ Mahmoud Fathalla Two major evidence-based cost- effective interventions to reduce maternal mortality •Quality of Care in Childbirth •Contraceptives/Family Planning Quality of care at Childbirth: a triple return on investment! Reducing Maternal and Newborn Mortality, preventing Stillbirths Filename MATERNAL DEATHS 13% UNSAFE ABORTIONS 47,000 DEATHS PATH PATH / BeckerEric © IN 3 DEATHS COULD BE AVOIDED IF ALL WOMEN HAD ACCESS CONTRACEPTIVES 110M FEWER UNINTENDED PREGNANCIES 50M FEWER ABORTIONS 220,000 FEWER WOMEN DYING 3M FEWER BABIES DYING The Sustainable Development Goals are here! The 17 Sustainable Development Goals 169 targets 1. Poverty 10. Equity 2. Food security and nutrition 11. Cities 3. Health 12. Consumption and production 4. Education 13. Climate change 5. Gender equality 14. Oceans, seas and marine 6. Water and sanitation resources 7. Energy 15. Ecosystems 8. Economic growth and 16. Peaceful and inclusive employment societies 9. Infrastructure, industrialization, innovation 17. Means of implementation Red: risk factors with direct effect on health Determinants: with indirect effect on health Update Rationale iv. Opportunities with the Sustainable Development Goals (SDGs) • People-centered goals • Holistic and inclusive agenda • Integrative approach recommended within and across sectors • Evidence on cost-effective SDG investments e.g. with the Copenhagen Consensus process GovernanceQuestion and Leadership 4. • National governance – representation and voice, effectiveness, regulation and rule of law, control of corruption, political vision What governance and • Global governance – actors’ comparative leadership approaches advantage, participation of low-income would help different actors countries, new models of development make best use of their partnership (e.g. south-south cooperation) comparative advantages • Leadership across society – public, private, for Every Woman Every civil society leadership, including through Child? multi-stakeholder partnerships HealthQuestion Interventions 1. RMNCH+A with SRHR, child health and development and women’s health • Sexual and reproductive health and rights • Maternal health • Newborn health • Child health and development • Adolescent health • Women’s health beyond reproduction Which health intervention areas are essential to end preventable mortality and promote the health of women and children? RENEWED GLOBAL STRATEGY FOR WOMEN’S, CHILDREN’S AND ADOLESCENTS’ HEALTH Unfinished agenda and emerging priorities Progress made: • Overall reduction of maternal and child mortality • We can envision to end ALL preventable deaths Remaining gaps and emerging priorities • Adolescents and young people • Stillbirths, newborns • Increasing burden of NCDs, cancers and mental health • Nutrition and environmental risk factors • Humanitarian settings and crisis situations 1. SURVIVE End preventable deaths 2. THRIVE Improve health and wellbeing 3. TRANSFORM Enhance systems and enabling environment The GS Goals and Targets is aligned with the SDGs, and finalized through a consensus process Objectives: 1. Strengthen care around time of birth 2. Strengthen health systems 3. Reach every woman and newborn 4. Harness power of parents, families, and communities 5. Improve data for decision making and accountability BMJ 2015;351:h4255 Towards ending preventable maternal and newborn mortality In 2013 : More than 3.0 million babies and 289.000 maternal deaths women could be saved each year 2.8 million newborn deaths 2.6 million stillbirths By 2030 in EVERY COUNTRY: MMR reduction of at least 2/3 from 2010 and MMR less than 140 NMR of less than 12 per 1000 live births Still births less that 12 per 1000 total births Update Rationale iv. Opportunities with the Sustainable Development Goals (SDGs) • People-centered goals • Holistic and inclusive agenda • Integrative approach recommended within and across sectors • Evidence on cost-effective SDG investments e.g. with the Copenhagen Consensus process GovernanceQuestion and Leadership 4. • National governance – representation and voice, effectiveness, regulation and rule of law, control of corruption, political What governance and vision leadership approaches • Global governance – actors’ would help different actors comparative advantage, participation of make best use of their low-income countries, new models of comparative advantages development partnership (e.g. south- for Every Woman Every south cooperation) Child? • Leadership across society – public, private, civil society leadership, including through multi-stakeholder partnerships HealthQuestion Interventions 1. RMNCH+A with SRHR, child health and development and women’s health • Sexual and reproductive health and rights • Maternal health • Newborn health • Child health and development • Adolescent health • Women’s health beyond reproduction Which health intervention areas are essential to end preventable mortality and promote the health of women and children? EnablersQuestion for health 2. services • Health Financing • Health Management • Health Workforce • Health Goods and Services • Health Information • Innovation • Infrastructure What are the main challenges to enabling faster progress on women’s and children’s health? Social and EnvironmentalQuestion 3. Determinants • Water, Sanitation and Hygiene (WASH) • Nutrition • Education • Women’s political and economic participation • Economic development and poverty reduction • Peace and security, including addressing violence against women What are the best ways to work with other sectors: e.g. defining shared goals and targets; joint advocacy and resource mobilization; collaborative projects …? Human RightsQuestion and Accountability 5. • Human rights e.g. human rights-based approach to reducing preventable maternal and child mortality and morbidity; social, economic, cultural and political participation; non-discrimination; equality of opportunities; indivisibility of rights • Accountability e.g. civil registration and vital statistics systems; accountability processes - monitoring, independent review and remedy How could human rights and accountability be even more powerful drivers of change for women’s and children’s health? Women, children, adolescentsQuestion their 5. families and communities Healthy people at the heart of sustainable development • Developing health literacy and health promoting skills • Using community engagement strategies based on the best evidence • Ensuring that all voices are heard and engaging in meaningful dialogue on women’s and children’s health • Addressing inequities, power disparities and other social barriers to progress • Legal empowerment to claim to essential health, development and humanitarian services How can a new Global